Relationships among visual acuity, risk of acute myocardial infarction, and stroke: a nationwide cohort study in south korea

ABSTRACT

Purpose

Visual impairment (VI) is highly prevalent in the elderly and is associated with functional decline. Previous research demonstrated an association between VI and cardiovascular events, but investigations have yet to be conducted in general population samples. We evaluated the relationship between visual acuity (VA) and development of cardiovascular diseases (CVD) in a nationwide Korean population.

Methods

This is a nationwide retrospective cohort study. We used the National Health Information Database of the National Health Insurance Service of Korea to identify subjects who participated in the National Health Insurance Service health screening program in 2012. We monitored 5,941,761 subjects for the development of cardiovascular diseases for a period of 5 years.

Results

After adjustments for age, sex, and other covariates, with subjects having a visual acuity better than 20/20 as the reference group, the adjusted hazard ratios (HRs) and 95% confidential intervals (CI) for acute myocardial infarction and stroke were visual acuity between 20/20 and 20/60, 1.073 (95% CI 1.053, 1.094) and 1.151 (95% CI 1.132, 1.171), respectively; for visual acuity between 20/60 and 20/200, 1.236 (95% CI 1.197, 1.277), and 1.336 (95% CI 1.302, 1.371), respectively; and for visual acuity worse than 20/200, 1.325 (95% CI 1.285, 1.366) and 1.383 (95% CI 1.349, 1.418), respectively.

Conclusion

Subjects with lower VA had higher risks of acute myocardial infarction and stroke. These results suggest that low VA is an independent risk factor for CVD.

KEYWORDS:

• visual acuity
• cardiovascular diseases
• acute myocardial infarction
• stroke

Abbreviations

AMI, acute myocardial infarction; BP, blood pressure; BMI, body mass index; CI, confidential interval; CVD, cardiovascular disease; NHID, National Health Information Database; NHIS, National Health Insurance Service; DBP, diastolic blood pressure; HDL, high-density lipoprotein; HR, hazard ratios; CI, confidence interval; ICD, International Classification of Diseases; KCD, Korean Classification of Diseases; LDL, low-density lipoprotein; PA, physical activity; SBP, systolic blood pressure; TC, total cholesterol; TG, triglyceride; VI, visual impairment; WC, waist circumference.

Authors’ contributions

Conception and design: Dong Hui Lim, Kyung-Shun Na

Data acquisition: Dong Hui Lim, Kyung-Shun Na

Data analysis and interpretation: Kyungdo Han

Drafting the manuscript: Gyule Han, Jisang Han

Critique and revision of manuscript: Jisang Han, Dong Hui Lim, Tae-Young Chung

Final approval of manuscript to be published: Dong Hui Lim, Kyung-Shun Na.

Conflicts of interest

None of the following authors have any proprietary interests or conflicts of interest related to this submission.

Data availability

The data used in this study are not available to other researchers because it is secured national data which only researchers who have permission from the Korean government can assess.

* Gyule Han and Jisang Han contributed equally to the article as the first authors.

^† Dong Hui Lim and Kyung-Shun Na are co-corresponding authors of this study.

Additional information

Funding

This work was supported by a National Research Foundation of Korea grant funded by the Korean government’s Ministry of Education (NRF-2019R1C1C1007917; Seoul, Korea) which was received by J.H, and a grant from the Korea Health Technology R&D Project through the Korea Health Industry Development Institute (KHIDI) funded by the Ministry of Health &Welfare, Republic of Korea (grant number: HI19C0481, HC19C0142), which was received by D.H.L.